Healthcare Provider Details

I. General information

NPI: 1710896782
Provider Name (Legal Business Name): MS. ERIN JADE FORKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3043 STATE ROUTE 4
HUDSON FALLS NY
12839-9632
US

IV. Provider business mailing address

14 MOON ST
FORT EDWARD NY
12828-1909
US

V. Phone/Fax

Practice location:
  • Phone: 518-747-8243
  • Fax:
Mailing address:
  • Phone: 518-932-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: